Medication-assisted treatment - limitations on carriers - rules

Official source

(1) Notwithstanding any provision of law to the contrary, beginning January 1, 2020, a carrier that provides prescription drug benefits for the treatment of substance use disorders shall, for prescription medications that are on the carrier's formulary:

(a)Not impose prior authorization requirements on any…#

(a) Not impose prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders;

(b)Not impose any step therapy requirements as a…#

(b) Not impose any step therapy requirements as a prerequisite for coverage for a prescription medication approved by the FDA for the treatment of substance use disorders;

(c)Place at least one covered prescription medication…#

(c) Place at least one covered prescription medication approved by the FDA for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the carrier; and

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Medication-assisted treatment - limitations on carriers - rules

Official source

(1) Notwithstanding any provision of law to the contrary, beginning January 1, 2020, a carrier that provides prescription drug benefits for the treatment of substance use disorders shall, for prescription medications that are on the carrier's formulary:

(a)Not impose prior authorization requirements on any…#

(a) Not impose prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders;

(b)Not impose any step therapy requirements as a…#

(b) Not impose any step therapy requirements as a prerequisite for coverage for a prescription medication approved by the FDA for the treatment of substance use disorders;

(c)Place at least one covered prescription medication…#

(c) Place at least one covered prescription medication approved by the FDA for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the carrier; and

(d)Not exclude coverage for any prescription medication…#

(d) Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services solely on the grounds that the medications and services were court ordered.

(1.5) The commissioner, in consultation with the department of public health and environment, may promulgate rules or seek a revision to the prescription drug benefits required under the essential health benefits package concerning prescription medications that must be included on a carrier's formulary for medication-assisted treatment of substance use disorders.

(2) Repealed.